{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T05:04:45Z","timestamp":1780117485410,"version":"3.54.0"},"reference-count":52,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Which advanced imaging modality\u2014computed tomography pulmonary angiography (CTPA) or lung scintigraphy\u2014is optimal to evaluate for suspected pulmonary embolism (PE) in pregnancy is debated. Practice patterns, prevalence of indeterminate imaging, and clinician response in contemporary community hospitals are not well understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included gravid adults in the emergency department (ED) and Labor and Delivery units (LDUs) who underwent advanced PE imaging 10\/1\/2021\u20133\/31\/2023. We excluded patients with COVID\u201019. Physician preferences were compared overall and in the subset of scintigraphy\u2010eligible cases, i.e., those with imaging ordered when scintigraphy was available (7:00\u2009a.m.\u20135:00\u2009p.m.) and not contraindicated by abnormalities on chest radiography (CXR). We reported 48\u2010h incidence of post\u2010indeterminacy imaging and 90\u2010day incidence of venous thromboembolism (VTE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 315 eligible cases, the median patient age was 31.0\u2009years (IQR 26.5\u201335.5) with 164 (52.1%) in the third trimester. Index images included 288 (91.4%) CTPA and 27 (8.6%) scintigraphy, 25 of which were low\u2010dose perfusion scans. PE was diagnosed in 5 (1.6%), all by CTPA. Among 116 scintigraphy\u2010eligible cases, CTPA was favored: 82.8% versus 17.2%, with similar patterns between ED\u00a0and LDU clinicians. CTPA diagnosed pneumonia in 6 cases (2.1% of 288) not previously identified on CXR and excluded pneumonia in 5 cases in which CXR suggested consolidation. Indeterminacy was more common with non\u2010positive CTPA (24.7% [70\/283]) than non\u2010positive scintigraphy (0% [0\/27]),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001. Only 7.1% (5\/70) of patients with suboptimal non\u2010positive CTPA received advanced imaging within 48 h, and none of the remaining 65 patients developed VTE or died within 90\u2009days.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this multicenter community setting with a low prevalence of PE, CTPA was preferentially ordered over lung scintigraphy in both the ED and LDU, even when both modalities were available and indicated. Indeterminate results were more prevalent with CTPA and often failed to trigger additional advanced imaging.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.70153","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T06:58:58Z","timestamp":1759301938000},"page":"1288-1298","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Advanced Imaging in Suspected Antenatal Pulmonary Embolism in Community Practice: Preferences, Indeterminacy, and Clinician Response"],"prefix":"10.1111","volume":"32","author":[{"given":"David R.","family":"Vinson","sequence":"first","affiliation":[{"name":"The Permanente Medical Group  Pleasanton California USA"},{"name":"Kaiser Permanente Northern California Division of Research  Pleasanton California USA"},{"name":"Department of Emergency Medicine Kaiser Permanente Roseville Medical Center  Roseville California 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S.","family":"Poth","sequence":"additional","affiliation":[{"name":"The Permanente Medical Group  Pleasanton California USA"},{"name":"Department of Emergency Medicine Kaiser Permanente South San Francisco Medical Center  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas H.","family":"Urbania","sequence":"additional","affiliation":[{"name":"The Permanente Medical Group  Pleasanton California USA"},{"name":"Department of Radiology Kaiser Permanente Oakland Medical Center  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan D.","family":"Niederkohr","sequence":"additional","affiliation":[{"name":"The Permanente Medical Group  Pleasanton California USA"},{"name":"Department of Nuclear Medicine Kaiser Permanente Santa Clara Medical Center  Santa Clara California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary 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